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1.
J Orthop Sci ; 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31420210

RESUMO

BACKGROUND: Soft tissue sarcomas can invade the skin and occasionally present as malignant wounds characterized by bleeding, exudate, odor, and infection. This study aimed to highlight the clinical problems associated with sarcomas with malignant wounds. METHODS: The patient group comprised 12 males and 1 female, with a median age at diagnosis of 75 (range 23-95) years old. The average follow-up was 28.3 months. Clinical information concerning the patients with soft tissue sarcomas presenting as malignant wounds was retrospectively investigated. RESULTS: Eleven out of 13 malignant wounds cases were male and over 65 years old. Tumors were located in the chest wall in 4 patients and the thigh in 4, respectively. The histology was high-grade in 12 patients. Persistent bleeding from malignant wounds was observed in 6 patients. The patients' pre-operative hemoglobin level was 7.5 ± 1.9 g/dl. For the purpose of temporary hemostasis, Mohs' paste was applied in 1 case and zinc oxide starch was applied in 3. Surgical removal was done in 10 patients, and amputation in 2. Six patients needed skin reconstruction. Post-operative surgical site infection was found in 5 patients, but the infection did not occur in the patients who underwent skin reconstruction of musculocutaneous flaps. The 5-year survival rate was 25.4%. CONCLUSIONS: Massive bleeding from the tumor impairs patients' quality of life and can be life-threatening. To avoid exacerbating the systemic condition of elderly cancer patients, urgent surgical removal is recommended, especially in cases of exposed tumors with persistent bleeding. Orthopedic oncologists should be aware of surgical site infection as a potential post-operative complication.

2.
Anticancer Res ; 39(8): 4191-4197, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366505

RESUMO

BACKGROUND/AIM: Biopsy hole for bone tumour biopsy may cause pathological fractures. This study aimed to identify the optimal shape of bone tumour biopsy hole using the rabbit femoral head compression test to avoid pathological fracture. MATERIALS AND METHODS: A compression test with no defect was performed to identify bone fracture location. Three shapes of biopsy holes (same size) were made artificially. Sixty rabbit femurs were randomly divided (n=15 each) into control (no defect), Shape 1 (round), Shape 2 (square), and Shape 3 (rectangular) groups. RESULTS: Twelve out of fifteen femurs were fractured on the femoral shaft; the femoral shaft was targeted for the compression test. Compressive maximum load and fracture energy were significantly higher for Shape 3 than for the other Shapes. CONCLUSION: A rectangular biopsy hole helps minimise reduction in bone strength. The defect width may be related to fragility of the affected bone.


Assuntos
Biópsia/efeitos adversos , Neoplasias Ósseas/fisiopatologia , Fraturas do Fêmur/fisiopatologia , Fêmur/fisiopatologia , Animais , Fenômenos Biomecânicos , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico , Modelos Animais de Doenças , Fraturas do Fêmur/diagnóstico , Humanos , Coelhos
3.
Trauma Case Rep ; 17: 1-4, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30310838

RESUMO

Sternoclavicular joint dislocation (SCJD) is a rare injury; there are only two reported cases of SCJD that have occurred during judo practice. We present a case of an 18-year-old male athlete who fell while practicing judo and experienced upper left chest pain. He was diagnosed with posterior SCJD at another institute before being transferred to our hospital. Closed reduction was initially not possible using traditional methods. Reduction was eventually accomplished by clamping the proximal end of the clavicle using bone forceps and rotating it while pulling it upward. Many authors have reported that closed reduction is difficult if not performed within 48 h after SCJD injury. However, we were able to achieve closed reduction approximately 72 h after injury. We found that reduction might be easily accomplished by pulling the proximal end of the clavicle up and rotating it when other closed reduction methods are unsuccessful.

4.
Anticancer Drugs ; 29(8): 806-809, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30110017

RESUMO

Epithelioid sarcoma (ES) is a rare and aggressive type of soft tissue sarcoma with resistance to systemic chemotherapy. Therefore, new treatment options are required for patients with advanced ES. Eribulin is a novel potential treatment option for patients with inoperative sarcoma. We herein report a case of a 27-year-old Japanese man with cystic lung metastases from an ES in the left forearm, resulting in long-term stable disease. A solid, metastatic sarcomatous nodule appeared in the right lung, as shown by computed tomography, within the first 2 months after surgery. After the lung metastasis was detected, he underwent a total of 37 cycles of chemotherapy in six regimens. However, multiple cystic lung metastases had progressed in segments S6 and S9/10; hence, eribulin treatment was initiated. After two courses of eribulin, the excess fluid density material in the cystic metastases was completely absorbed, and an additional four courses of treatment resulted in shrinkage of the cystic metastases. These effects lasted for 13 months without severe adverse effects. Cystic lung metastases are an extremely rare consequence of soft tissue sarcoma, and eribulin is one of the most promising options for the treatment of advanced ES.

5.
Mol Clin Oncol ; 9(2): 187-191, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30101019

RESUMO

Methotrexate (MTX) is the key drug for the treatment of rheumatoid arthritis (RA). MTX-treated RA has been associated with the development of lymphoproliferative disorders (LPDs). Notably, the hyperimmune state of RA itself or the immunosuppressive state induced by MTX administration may contribute to development of LPD. Furthermore, Epstein-Barr virus (EBV) has been indicated to contribute to the development of MTX-LPD. MTX-associated LPD (MTX-LPD) may affect nodal or extranodal sites, including the gastrointestinal tract, skin, lungs, kidneys, and soft tissues, at an almost equal frequency. However, it is rare for MTX-LPD to manifest as multiple bone tumors with a pathological fracture. The present study reported the case of a 46-year-old Japanese woman with RA who had complications of EBV-positive MTX-LPD during an approximate 5-year course of MTX therapy. The present study indicated a rare case in which the LPD had spread to multiple bones in a patient with a pathologic fracture. Notably, the LPD was subclassified as diffuse large B-cell lymphoma (DLBCL).

6.
Oncol Lett ; 15(4): 4531-4534, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29541222

RESUMO

Circumscribed solid nodules are common in pulmonary metastases from sarcoma, but cystic pulmonary metastases from sarcomas are extremely rare. An unusual case of a 33-year-old man presenting with left spontaneous pneumothorax in association with cystic pulmonary metastases from an epithelioid sarcoma in the left forearm was discussed in the present study. The patient underwent wide resection of an epithelioid sarcoma in the left forearm 6 years prior. Periodical computed tomography revealed a gradual increase in the number and size of bilateral multiple cystic pulmonary metastases despite repeated chemotherapy treatment. At 33 years of age, the patient visited the outpatient department for sudden left chest pain and dyspnea. Plain radiography demonstrated spontaneous pneumothorax in the left lung; chest tube insertion and pleurodesis were successfully performed thereafter. At the last follow-up, 24 months after spontaneous pneumothorax, he is still alive and receiving chemotherapy treatment. Spontaneous pneumothorax is a common complication associated with cystic pulmonary metastases from epithelioid sarcoma. Orthopedic oncologists need to be aware of this unusual sarcomatous metastasis during the follow-up of advanced epithelioid sarcoma.

7.
PLoS One ; 13(12): e0209642, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30596710

RESUMO

PURPOSE: Many surgeons participate in the management of superficial soft tissue masses, and a preoperative incorrect diagnosis frequently results in dismal oncological outcomes. The aim of this study was to identify distinguishing magnetic resonance imaging features between malignant and non-malignant lesions. METHODS: The clinicopathological data for 219 patients (men 114; women 105) with superficial soft tissue masses treated from January 2007 to December 2016 in our institution were retrospectively analyzed. The median age at the first visit was 55.6 years (range 1-90 years). MRI findings of tumor size, margin, lobulation, intratumoral hemorrhage, peritumoral edema, and tumor-fascia relationship were compared with the final histological diagnosis and tumor grade. RESULTS: Univariate analysis revealed significant relationships between histologically malignant lesions and tumor size ≥5 cm (p = 0.035), positive peritumoral edema (p = 0.031), and tumor-fascia relationship (p<0.001), but not margin (p = 0.107), lobulation (p = 0.071), and intratumoral hemorrhage (p = 0.17). In addition, using multivariate analysis, the tumor-fascia relationship (p<0.001) and tumor size were significant factors. A significant correlation between tumor-fascia relationship and malignancy (p<0.001) was observed; such a relationship was, however, not observed for tumor grade (p = 0.43). CONCLUSIONS: Tumors measuring ≥5 cm and the tumor-fascia relationship on magnetic resonance imaging are highly indicative of malignancy. When superficial soft tissue masses cross the superficial fascia and form obtuse angles with the fascia, sarcoma should be considered. The tumor-fascia relationship can offer surgeons useful information regarding the status of superficial soft tissue masses.


Assuntos
Fáscia/patologia , Imagem por Ressonância Magnética , Neoplasias de Tecidos Moles/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Lactente , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tela Subcutânea/patologia , Carga Tumoral , Adulto Jovem
8.
Oncol Lett ; 10(3): 1799-1804, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26622753

RESUMO

The number of patients with primary malignant bone and soft tissue tumors in Japan is increasing in line with the increasing size of the elderly population. The aim of the present study was to determine the prognostic factors of primary malignant bone or soft tissue tumors in elderly patients. Clinical data was obtained from 90 patients, aged ≥65 years, with primary malignant bone or soft tissue tumors (bone, 20 cases; and soft tissue, 70 cases), treated at the Osaka City University Hospital between 1993 and 2013. Clinical information prior to treatment and tumor type, location, size, depth, grade and American Society of Anesthesiologists-Physical Status (ASA-PS) score were evaluated in order to identify prognostic factors using the Cox proportional hazards regression model. In addition, 5-year survival rates were evaluated using the Kaplan-Meier method. The average follow-up period was 44.8 months and the 5-year overall survival rate was 77.5%. In the multivariate analysis, ASA-PS score and high-grade sarcoma were found to be associated with a poorer overall survival. No significant differences were observed between the patient group aged 65-74 years and that aged ≥75 years. In general, aging is associated with physically reduced function and an increased prevalence of comorbidities. It was therefore expected that increasing age may be a predictive factor for poor prognosis. However, the results of the present study suggested that ASA-PS score and tumor grade were significant factors associated with poor prognosis, whereas increasing age was not. Therefore, the treatment of elderly patients with primary bone and soft tissue tumors should not be based on age.

9.
Mol Clin Oncol ; 3(2): 367-374, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25798269

RESUMO

This study was conducted to investigate marriage and fertility in long-term survivors with high-grade bone and soft tissue tumors following chemotherapy. We reviewed issues related to fertility in 47 patients (24 men and 23 women) who had survived for >5 years. The median age at diagnosis was 18.0±8.9 years and the mean duration of follow-up 11.0 years. We investigated the proportions of married subjects (number of married/total number of subjects) and fertile subjects (number who had fathered or conceived offspring/total number of subjects), the interval between first delivery and last chemotherapy, type of delivery, congenital deformities in the offspring and the association between cumulative dose of chemotherapeutic agents and subsequent reproduction. The final proportions of married and fertile subjects following sarcoma treatment were 36.2% (17/47) and 29.8% (14/47), respectively. Two subjects had fathered and 8 had conceived a total of 15 offspring. The proportion of fertile men was significantly lower compared to that of women. The mean interval between the last chemotherapy and the first delivery was 9.5 years. Of the 10 first births, 6 were normal transvaginal deliveries and 4 were caesarean sections (1 was a medical termination due to lung metastases, 1 was due to infected amniotic fluid caused by uterine myomas and 2 were performed due to abnormal rotation of the fetus). No offspring presented with congenital deformities. Fertile men had received smaller cumulative chemotherapeutic agent doses, particularly of ifosfamide, compared to those who had not fathered any offspring. In conclusion, infertility occurs more frequently in men compared to women following intensive chemotherapy. All the patients should be offered counseling regarding the potential risk of infertility prior to cancer treatment.

10.
Oncol Lett ; 10(6): 3529-3531, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26788163

RESUMO

Reconstruction following periacetabular tumor resection of the pelvis is one of the most challenging issues in limb salvage surgery. An ideal procedure has still not been established. There are several reconstruction methods available, including arthrodesis, pseudoarthrosis, resection arthroplasty, prosthetic arthroplasty, saddle prosthesis, allograft and hip transposition. In our hospital, we have been using a flail hip joint procedure without reconstruction. Herein, we report good extremity function following a flail hip joint procedure which used the upper surface of the femoral neck as a saddle facing the remaining ilium. To the best of our knowledge, among the reported flail hip joint cases, this procedure has never been used. The patient is able to walk without any pain for several hundred meters with a shoe lift but without a cane, as observed at a 20-year follow-up. The authors consider that the flail hip joint using the upper surface of the femoral neck as a saddle is a simple and effective method.

11.
Mol Clin Oncol ; 2(6): 1111-1114, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25279207

RESUMO

Only a limited number of orthopedic oncologists make arrangements for pre-chemotherapy fertility preservation, such as sperm cryopreservation, for their patients. The purpose of this study was to offer fertility preservation to male patients with high-grade malignant bone and soft tissue tumors and assess the outcomes. The study included 14 male patients, aged <45 years, with high-grade bone and soft tissue tumors. The median age at diagnosis was 23.0±12.0 years (range, 8-42 years). Following pathological confirmation of high-grade malignant tumor, we informed all the patients and/or their guardians on the issue of chemotherapy-related male infertility. If the patients were interested in preserving fertility, they were referred to a team of reproductive specialists. We documented the patients' clinical characteristics and techniques used for fertility preservation. The majority of unmarried and childless patients were interested in fertility preservation. Four patients (28.5%) selected sperm cryopreservation and 1 patient (7.1%) selected hemi-testicular preservation, as he had developed erectile dysfunction following previous surgery for colon cancer. Married patients and those with children did not wish to preserve fertility. In conclusion, infertility following chemotherapy raises serious concerns for young male patients with high-grade bone and soft tissue tumors. Prior to initiating chemotherapy, the potential risks of chemotherapy should be explained, counseling should be provided and informed consent should be obtained from the patients, ideally without delaying commencement of cancer treatment. Prior to administering cancer chemotherapy, orthopedic oncologists are encouraged to offer sperm banking to young male patients at risk of infertility.

12.
Oncol Rep ; 32(4): 1654-60, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25109621

RESUMO

Resolution of ultrasonography (US) has undergone marked development. Additionally, a new-generation contrast medium (Sonazoid) used for US is newly available. Contrast-enhanced US has been widely used for evaluating several types of cancer. In the present study, we evaluated the ability of color Doppler US (CDUS) and Sonazoid to differentiate between benign and malignant soft tissue tumors. A total of 180 patients (87 male, 93 female) were enrolled in the present study. The patient ages ranged from 1 to 91 years (mean 58.1±20.0 years). The maximum size, depth, tumor margins, shape, echogenicity and textural pattern were measured on gray-scale images. CDUS was used to evaluate the intratumoral blood flow with and without Sonazoid. Peak systolic flow velocity (Vp), mean flow velocity (Vm), resistivity index (RI) and pulsatility index (PI) of each detected intratumoral artery were automatically calculated with power Doppler US (PDUS). The present study included 118 benign and 62 malignant tumors. Statistical significances were found in size, depth, tumor margin and textural pattern but not in shape or echogenicity on gray-scale images. Before Sonazoid injection, CDUS findings showed 55% sensitivity, 77% specificity and 69% accuracy, whereas contrast-enhanced CDUS showed 87% sensitivity, 68% specificity and 74% accuracy. There were no statistically significant differences between malignant and benign tumors regarding the mean Vp, Vm, RI and PI values determined on PDUS. In conclusion, contrast-enhanced CDUS proved to be a reliable diagnostic tool for detecting malignant potential in soft tissue tumors.


Assuntos
Meios de Contraste , Compostos Férricos , Ferro , Lipoma/diagnóstico por imagem , Lipossarcoma/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Óxidos , Neoplasias de Tecidos Moles/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Criança , Pré-Escolar , Cisto Epidérmico/irrigação sanguínea , Cisto Epidérmico/diagnóstico , Cisto Epidérmico/diagnóstico por imagem , Feminino , Cistos Glanglionares/irrigação sanguínea , Cistos Glanglionares/diagnóstico , Cistos Glanglionares/diagnóstico por imagem , Humanos , Lactente , Lipoma/irrigação sanguínea , Lipoma/diagnóstico , Lipossarcoma/irrigação sanguínea , Lipossarcoma/diagnóstico , Masculino , Pessoa de Meia-Idade , Neurilemoma/irrigação sanguínea , Neurilemoma/diagnóstico , Sensibilidade e Especificidade , Neoplasias de Tecidos Moles/irrigação sanguínea , Neoplasias de Tecidos Moles/diagnóstico , Carga Tumoral , Adulto Jovem
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